It’s been a horrible year for individual liberty. First, John Roberts re-writes the Obamacare legislation in order to side with the four liberals on the U.S. Supreme Court to uphold the constitutionality of the individual mandate. Then Mitt Romney, a moderate technocrat, failed to make the case to change course with the electorate, in my view largely because he was unable to effectively challenge Obamacare. The federal noose is tightening inexorably around our collective neck! How can we, as individuals, defend our families and ourselves? These are desperate times and require desperate measures. Allow me to suggest a few.

There is simply no way that greatly expanded federal control over medicine will be anything but a disaster. Central planners will tighten their grip using price controls and other heavy-handed means of “cost control” that will inevitably mean shortages and rationing. To understand how this happens, look no further than hours-long lines to get gasoline in New York and New Jersey. These are a direct result, not of Hurricane Sandy, but of the strict “anti-gouging” laws in these states that prevent retailers from raising prices in response to scarcity. Higher prices will signal suppliers to overcome barriers to delivering more supply. Gas lines would vanish overnight with suspension of price controls. In medicine, price controls on doctors and hospitals will mean shortages of both.

To assure continued access to a personal physician, concerned Americans should immediately seek out and contract with a direct-pay or concierge doctor. This is even more important if you have significant medical problems. You will not get the care you need in Medicaid, or an “Accountable Care Organization,” the latest version of managed care.

Doctors should strongly consider opting out of Medicare and other major third-party payers, as our practices will increasingly be under their direct control. If a critical mass of physicians opt out, it will be difficult for the federal government to compel participation.

To pay for care, consider setting up a Health Savings Account, which somehow survived Obamacare, albeit with some restrictions. The HSA can be used to pay for routine care, such as office visits and tests. Get used to the idea of paying directly for your routine care. An HSA should be coupled with a catastrophic insurance policy with a high deductible. These too are still available. The Association of American Physicians and Surgeons has information on all of the above, and frequently sends updates on Twitter.

This leads to my final recommendation: If you live in a blue state, consider relocating to a red state, particularly one that is not complying with Obamacare. According to Twila Brase, we can add Montana, Alabama, and Wyoming to the list of states refusing to set up the Obamacare state insurance “exchanges.” The U.S. Supreme Court ruled that the federal government couldn’t force states to expand Medicaid, or set up exchanges. States that opt out effectively defend their citizens from some of the more objectionable aspects of Obamacare.

There are other major advantages for conservatives who move from a blue to a red state. Your vote will suddenly count, and over time, the Electoral College and Congress will shift to favor red states. You will also enjoy lower taxes and cost of living, and if moving from the northeast, a better climate! Many of the blue states, such as California, New York, Illinois, and Michigan, are in dire financial straits due to high taxes, public sector unionism, and overspending on welfare programs, including Medicaid. If millions of productive conservatives (i.e., taxpayers) bail out, the fiscal picture worsens considerably and these states will either collapse or reform. Long term, this is the only way to win the non-shooting civil war that is raging between those who favor expanding the welfare state and those who desire a return to our founding principles of a limited federal government and max imal personal freedom.

Richard Amerling, MD is a nephrologist practicing in New York City. He is an Associate Professor of clinical medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence. Follow Dr. Amerling on Twitter at http://twitter.com/dramerling.